The Pain–Depression Connection

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When you’re in pain, it affects every aspect of your life. Even engaging in the most basic of activities — taking care of your children, spending time with friends, enjoying your favorite hobbies — can be uncomfortable at best, and excruciating and impossible at worst.

Of course, when you cannot engage in the activities you enjoy, it may seem easier to withdraw and isolate yourself from the world. You might feel hopeless as if you will never enjoy anything again thanks to your pain, and as a result, lash out at those we care about the most, and feel irritable most of the time. In short, you become depressed, and according to researchers, you might even exacerbate your pain.

pain-and-depressionDoctors have long suspected a strong connection between pain and depression. In fact, according to Harvard research, those who suffer from chronic pain are three times more likely to suffer from psychiatric symptoms (including depression) and those with depression have the same elevated risk for developing chronic pain.

The International Association of Pain actually defines pain as one’s emotional response to actual or potential tissue damage. The question remains, though, which comes first — and how to do you effectively treat both conditions?

A Possible Explanation
While depression that comes after pain is often attributed to the life-changing effects of pain, the reasons for depression-related pain are generally less clear. Neurologists believe that the connection between pain and mood is due to the way that our brains are wired.

The human body is designed with built-in protection mechanisms that allow us to feel pain, but also blocks sensations to allow us to focus on other important functions. For example, say that you bang your elbow on a doorway. Chances are, it will hurt for a few moments, but the pain will quickly fade and you can go about your day. That’s your body’s way of saying “Hey, don’t do that!” Now, assume that you hit your arm so hard that you fractured the bone. Your brain will register more severe pain for a longer period, indicating that you should see a doctor.

For most people, that pain receptor works normally. However, if for some reason the receptors that are responsible for perceiving and blocking pain aren’t working properly, then one might feel more pain than normal, and for longer periods of time — i.e., chronic pain. Further complicating matters is the fact that the same pathways in the brain that handle the neurotransmitters responsible for sending and receiving pain signals are the same as those that handle the ones responsible for regulating mood (serotonin and norepinephrine). Because the “shutoff” mechanism for pain isn’t working correctly, it only follows that the same issue applies to the mood chemicals, thereby heightening the feelings of anxiety and depression.

Treating Pain and Depression Together
The indisputable connection between pain and depression makes it clear that chronic pain treatment options must include a mental health component as well as addressing the symptoms and underlying causes of ongoing pain.

Often, the two conditions are treated separately, but more practitioners are beginning to recognize the need to treat them concurrently. Medical and mental health providers need to work closely together and develop a treatment plan that addresses both the physical and emotional needs of the patient.

That usually means that in addition to treating pain with medication, surgery, or other medical interventions, patients receive mental health support as well. This might include:

Antidepressants
Medication for depression or anxiety can help relieve pain due to the shared neurotransmitter pathways; in other words, the drugs can block the sensation of pain as well as the hormones and chemicals that lead to mood disruptions.

Therapy
Working with a therapist can help depressed patients handle the emotions associated with their pain, and develop strategies for managing them more effectively. Different types of therapy allow patients to learn new behaviors for dealing with their pain, responses to discouraging or painful thoughts, and to eliminate the types of thoughts and behaviors that limit their recovery, such as fear of pain when performing certain activities. Incorporating other types of therapeutic activities, including journaling, art, or music therapy, can also reduce stress and typical triggers of anxiety.

Physical Therapy and Rehabilitation
Rehabilitation services help relieve physical symptoms of pain while building confidence and new strategies for managing everyday tasks.

Because pain and depression are inextricably linked, and each individual is different, health care providers may need to experiment with a variety of treatment options before finding the combination that works best. However, by looking at the entire patient, both body and mind, chronic pain treatment can be more effective.

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